When it comes to digestive distress, few things are as frustrating or as commonly misunderstood as acid reflux. Millions of Americans pop antacids like candy, assuming their problem is simply “too much stomach acid.”
But what if I told you that the real culprit behind your heartburn isn’t too much acid, but rather too little acid, in the wrong place, at the wrong time—caused by a hidden gut imbalance?
One of the most overlooked triggers behind acid reflux is SIBO—Small Intestinal Bacterial Overgrowth. Let’s unpack this gut-health mystery, and if the following symptoms sound familiar, get you on the road to lasting relief.
The Gut-Acid Reflux Connection
In my 35+ years of clinical practice, I’ve witnessed how poor digestion often masquerades as excess acid. But quite often, low stomach acid is one of the most common issues in reflux patients. And here’s where SIBO steps into the spotlight.
How SIBO Triggers Reflux?
The relation between reflux and SIBO is here.
Gas Pressure from Fermentation
Bacteria in the small intestine ferment undigested carbohydrates, especially the “carbs from hell” like white bread, soda, and sugary snacks. This fermentation process creates gas, which increases intra-abdominal pressure.
That pressure can force open the lower esophageal sphincter (LES), the valve that separates your stomach from your esophagus, allowing acid to escape upward.
Delayed Gastric Emptying
SIBO slows down digestion. When food lingers in the gut, it ferments, and the resulting gas and bloating can push stomach contents into the esophagus. It’s not the acid’s fault—it’s the faulty traffic flow.
Bile Dysfunction
SIBO often disrupts bile flow, which is crucial for fat digestion. Without adequate bile, food remains undigested, exacerbating reflux and bloating. This is especially common in people who’ve had their gallbladder removed—a frequent finding in my clinic.
Misdiagnosis: When the Symptoms Lie
Many people diagnosed with GERD (Gastroesophageal Reflux Disease) actually have underlying SIBO. They’re told to take medications known as proton-pump inhibitors (PPIs), which suppress stomach acid. But here’s the real problem: They need stomach acid to protect against infections like SIBO and to digest their food properly.
Suppressing acid may give temporary symptom relief, but long-term use often backfires, making SIBO worse and leading to nutrient deficiencies, especially in B12, calcium, and iron.
Real Healing Begins in the Gut
So, what’s the answer? You need to fix the bacterial imbalance at the root of the issue, not just mask the symptoms. Here’s what I recommend:
The right questions need to be asked
If you’re struggling with acid reflux, asking the right questions is not optional—it’s essential. My targeted questionnaire can quickly uncover if SIBO (Small Intestinal Bacterial Overgrowth) is the hidden culprit behind your acid reflux.
A simple questionnaire can identify if your symptoms are triggered by SIBO.
Starve the Bad Guys
Eliminate the bacteria’s favorite foods—refined sugar, alcohol, and processed carbs. Instead, nourish your body with “carbs from heaven”: fresh vegetables, legumes, and fiber-rich whole foods. These support healthy bacteria without fueling the overgrowth.
Support Digestive Fire
Contrary to popular belief, many people need more stomach acid, not less. Apple cider vinegar or betaine HCl (under supervision) can support proper acid levels and digestion, discouraging bacterial overgrowth.
Rebuild the Gut
Using probiotics, digestive enzymes, and gut-healing nutrients like aloe vera and slippery elm can help repair the intestinal lining and restore balance.
Address Stress and Toxins
As I detail in Goodbye Illness, Hello Wellness, stress, toxins, and hidden food allergies also play a role in gut dysfunction. A comprehensive plan that includes detoxification, stress reduction, and an allergy-free diet may be essential to fully resolving reflux.
The Functional Medicine Edge
Conventional doctors are trained to suppress symptoms. But functional medicine—what I practice—is about finding the root cause. SIBO is often the upstream issue driving downstream problems like acid reflux, fatigue, and even autoimmune conditions. When we correct the gut imbalance, the symptoms disappear.
If you’re tired of the antacid merry-go-round and ready to heal, not just cope, look deeper. Trust your gut… and fix it.
Final Thoughts
If you’ve been struggling with acid reflux despite taking all the right medications, it may be time to flip the script. SIBO could be the hidden cause. Restore the balance of bacteria, support your digestive system, and let your body do what it was designed to do—heal.
Your journey to wellness doesn’t begin in the pharmacy—it begins in your gut.